Treatment for Overtraining Syndrome
The treatment for overtraining syndrome should be individually developed and include relative or absolute rest depending on the clinical situation, along with evaluation for mental health stressors. 1
Diagnosis and Recognition
Before initiating treatment, it's important to recognize overtraining syndrome, which presents as:
- Chronic fatigue and underperformance
- Increased vulnerability to infections
- Mood disturbances
- Sleep disturbances
- Persistent muscle soreness/stiffness
- Long-term competitive incompetence
Signs of overtraining to watch for include:
- Inability to finish training sessions with reserve
- Inability to converse during activity due to breathing difficulty
- Faintness or nausea after exercise
- Chronic fatigue throughout the day
- Sleep disturbances
- Joint pain and muscle stiffness 1
Treatment Algorithm
1. Rest and Recovery (Primary Intervention)
- Relative or absolute rest is the cornerstone of treatment 1
- For mild cases (functional overreaching): 1-2 weeks of reduced training
- For severe cases (non-functional overreaching or overtraining syndrome): Complete cessation of training for 2-6 weeks
2. Mental Health Assessment
- Evaluate for mental health stressors that may be contributing to or resulting from overtraining 1
- Consider cognitive behavioral therapy (CBT) for associated anxiety or stress 1
3. Nutrition and Hydration Optimization
- Ensure optimal nutrition and hydration status 1
- Monitor energy availability to prevent relative energy deficiency in sport (RED-S) 1
- Consider assessment of endocrine biomarkers to identify energy deficiency
4. Sleep Restoration
- Implement sleep hygiene practices
- Insomnia-specific CBT is first-line treatment for sustained improvements in sleep 1
- Avoid benzodiazepine sedative hypnotics due to negative impact on reaction time 1
5. Training Modification
- Implement systematic monitoring of training loads 1
- Ensure adequate rest periods between training sessions 1
- Start slowly and progress gradually when returning to training 1
Recovery Timeline and Prognosis
Recovery time depends on severity:
- Functional overreaching: Days to 2 weeks
- Non-functional overreaching: 2-6 weeks
- Full overtraining syndrome: 6-12 weeks or longer 2
Prevention Strategies
Prevention is crucial and includes:
- Monitoring training loads to avoid excessive volume/intensity 1
- Ensuring adequate rest periods between training sessions 1
- Maintaining optimal nutrition and hydration status 1
- Regular screening for early signs of overtraining 3
- Implementing proper periodization of training 3
Common Pitfalls and Caveats
Premature return to training: Athletes often return to intense training too soon, which can prolong recovery or cause relapse 2
Overlooking non-training stressors: Stress is the sum of both training and non-training factors 4
Misdiagnosis: Overtraining syndrome shares symptoms with other conditions like chronic fatigue syndrome and major depression 5
Ignoring early warning signs: Psychomotor slowness may be an early marker of overtraining syndrome 5
Inadequate monitoring: Regular assessment should occur after regeneration periods to distinguish between short-term fatigue and chronic overtraining 3
By following this structured approach to treatment and implementing preventive strategies, athletes can recover from overtraining syndrome and reduce the risk of recurrence, ultimately improving their long-term health and performance outcomes.